Exercise Induced Bronchoconstriction
Key Points
Key Points
- The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
- Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
- The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
- The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
- EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
- Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.
Diagnosis
...gnosis...
...tement (SS)1: In asthmatic patients EIB can i...
...2: A diagnosis of EIB should be confirmed by dem...
...aluate EIB in elite athletes by using objective...
...Perform a standardized bronchoprovoca...
SS5: In subjects with no current clinical his...
...direct graded challenge (eg, mannitol, if availa...
...n indirect challenge (eg, exercise challenge o...
...re the ventilation reached and sustained during ex...
...rform EVH as the preferred surrogate challeng...
...: If an indirect graded challenge (eg, m...
...To differentiate between EIB and exercise-induc...
...S12: To determine whether exercise-induced...
...m spirometry, as well as detailed pulmonary examin...
...Consider a diagnosis of exercise-induced...
Treatment
Treatmen...
SS15: Refer to appropriate specialists (eg, card...
...: Refer patients for psychological evalua...
...chedule regular office visits with patient...
...2-Adrenergic Receptor...
...ribe inhaled short-acting β2-adrenergic recepto...
...cribe a single dose of SABA, LABA, or both on an...
...S20: Be cautious in daily use of β2-adrenergic...
...eukotriene Inhibito...
...sider prescribing daily therapy with leuko...
...ell Stabilizers...
...22: Consider prescribing inhaled cromoly...
ICSs
...sider prescribing ICSs in combinatio...
...prescribe daily LABAs with ICS therapy to...
...linergic Agents
...r prescribing inhaled ipratropium bromide for...
...harmacologic Therapy...
...S26: Prescribe pre-exercise warm-up f...
...ider with caution the recommendation o...
...etitive and Elite Athletes...
...athletes with EIB alone in a similar...
...rithm for the Diagnosis, Treatment, and Different...